6- Referral Guidelines Wrist and Hand AH Final

Orthopaedic Wrist and Hand Referral Guidelines

Austin Health Orthopaedic Clinic holds weekly multidisciplinary meetings to discuss and plan the treatment of patients with Orthopaedic and Fracture conditions.

Department of Health clinical urgency categories for specialist clinics

Urgent: A referral is urgent if the patient has a condition that has major functional impairment and/or moderate risk of permanent damage to an organ/bone/tissue/system if not seen within 30 days. For urgent referrals please contact Orthopaedic Registrar to discuss ? most urgent patients will be seen within 2 weeks. For emergency cases please send the patient to the Emergency department.

Semi Urgent Referrals should be categories as Semi Urgent that has the potential to deteriorate within 30-90 days.

Routine: Referral will be triaged by the Orthopaedic Liaison Nurse and Director of Orthopaedic Surgery. Appointments will be booked accordingly.

Exclusions

Condition / Symptom

GP Management

Minimum Required Referral Information

Expected Triage Outcome

Expected number of Specialist Appointments

Wrist Osteoarthritis Hand Osteoarthritis Carpal Collapse

? Medications (paracetamol, glucosamine, chondroitin sulphate, fish oil, NSAIDS if appropriate)

? Physiotherapy ? Hand Therapy ? Corticosteroid Injection of

affected joint(s) ? Orthotics (esp. bracing)

History -Symptoms, ADLs affected? -Treatment and responses to date

Examination Findings

Investigation (report with referral) -X-raysWrist and Hand XRsAP and Lateral Scaphoid Views As necessary

Urgent: N/A

Routine: Refer if maximal non-operative treatment (at least 2 modalities for at least 3 months) has failed

As required:

Instruct patient to bring films to the Specialist Clinic appointment.

Austin Health Orthopaedics Clinic Referral Guidelines | Created: 28/02/2013 | By: Orthopaedic Liaison Nurse | Last Reviewed: Andrew Hardidge 19/01/2018| Review & Update by: 19/01/2019

Department of Health clinical urgency categories for specialist clinics

? Patient referred to a Rheumatologist as appropriate

History -Loss of function? ADLs affected? Grip? -Treatment and responses to date

Inflammatory Arthritis (Rheumatoid, Other) Of

Wrist

Carpus

Fingers

Examination Findings Peripheral Stigmata

Investigation (report with referral) -X-raysWrist and Hand XRsAP and Lateral

and -Bloods FBE, ESR, CRP, RF, ANA, ANCA

Urgent: N/A

Routine: Refer if patient referred to rheumatologist and nonoperative measures have failed

Refer for Urgent Assessment if wasting is present

Instruct patient to bring films to the Specialist Clinic appointment.

History -Symptoms, ADLs affected? -Treatment and responses to date

Urgent: If wasting is present

Carpal Tunnel Syndrome

Otherwise:

? Medications (paracetamol, NSAIDS if appropriate)

? Physiotherapy ? Hand Therapy ? Injections (consider

radiologically-guided) ? Orthotics (esp. braces)

Examination Findings

Investigation (report with referral) -Nerve Conduction Study/ EMG Consider for clarification of diagnosis

Routine: Refer if maximal non-operative treatment (at least 2 modalities for at least 3 months) has failed

Instruct patient to bring films to the Specialist Clinic appointment.

As required: As required:

Austin Health Orthopaedics Clinic Referral Guidelines | Created: 28/02/2013 | By: Orthopaedic Liaison Nurse | Last Reviewed: Andrew Hardidge 19/01/2018| Review & Update by: 19/01/2019

Department of Health clinical urgency categories for specialist clinics

No Specific Management

History -ADLs

Dupuytren's Contracture

Examination Findings -measurement of joint deformities

Investigation None Required

Trigger Finger

? Cortisone Injection in tendon sheath (Consider radiologically-guided)

History -ADLs

Examination Findings

Investigation None Required

Urgent: N/A

Routine: Refer if the deformities are: ? Causing patient concerns ? affecting ADLs (Activities of

Daily Living) ? Age ................
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